As a military first responder for almost 30 years, I have lived in many communities and have had a front row seat to observe how emergency services are delivered in the name of public safety. In the community where I grew up, when a 911 call is made, a fire truck or an ambulance comes from the same local fire department. When I moved to Colorado Springs, it seemed odd to me that a 911 call would summon not only a fire truck with a paramedic to provide emergency medical care, but also an ambulance from a third-party, for-profit company. The fire department paramedic performs lifesaving rescues and then hands the patient over to a private ambulance to take them to the hospital. I wondered how this could be efficient and effective, but it seems not to be. Of the 40 largest cities in the country, only four continue to rely on private ambulance services for 911 calls (Portland, Las Vegas, Fresno, and Colorado Springs). The city is currently considering a proposal to transfer ambulances to the fire department, which would be consistent with best practices across the nation and would make more sense than current practice.
Whether provided by a private company or the fire department, the provision of emergency response is fundamentally a government responsibility. The Colorado Springs City Charter (8.2.303) states that the Colorado Springs Fire Department is responsible for “medical management at the scene of an accident or emergency” and “shall have the authority to administer all procedures necessary to ensure the continuing well-being of persons injured in an accident or subject to a medical emergency.” Some argue that private companies, being for-profit and relatively agile, can provide government services at a lower cost. Experience has shown that this is only sometimes true. When there is strong competition and a strong market, outsourcing can be the solution. Few private ambulance companies have the resources to cover a city the size of Colorado Springs. This weakens competition and can lead to what economists call market failure.
When the market fails and vendors are unable to provide the service, the onus shifts back to the government, whether they are ready or not. The responsible agency in this case, the Colorado Springs Fire Department, believes it can provide better and cheaper service than what is provided by the current commercial vendor, American Medical Response. I think it can.
At approximately 9 a.m. on June 11, the City Council will consider a proposal put forward by the city to transfer emergency medical transport to the fire department, eliminating the profit-making aspect that should be the clear focus of any business. During the City Council's most recent work session, the fire department cited years of questionable performance from vendors, including 33,000 late arrivals. The company paid fines for not meeting the responsiveness standards of the contract. While this may be business as usual for a company and an acceptable loss of revenue for the corporate office, it is unacceptable to citizens suffering through a medical crisis. As Chief Randy Royal noted during the meeting, these aren't just statistics, they are people.
The city has an excellent fire department. Despite a growing population and an ever-increasing number of calls, the firefighters are highly motivated to provide good service to the residents. The department has pioneered innovative initiatives that have had a positive impact on the quality of life and public health in the area.
Officials believe they can operate their emergency medical services business at a lower rate than what vendors are currently charging. Instead of adding money to the company's coffers, they aim to reinvest it in the business to reduce costs or expand services to the local community. We don't know if their estimates are accurate, but it can be hard to predict the future. If their estimates are correct, we stand to gain a lot, and it may be in our best interest to see them make the effort.
On June 11, the city council will end its reliance on private companies for emergency medical transport, giving emergency services workers the opportunity to do what they do best: save lives.
Dr. George E. Reed is dean and professor in the School of Public Service at the University of Colorado at Colorado Springs. His opinions do not necessarily reflect those of the University of Colorado.
Dr. George E. Reed is dean and professor in the School of Public Service at the University of Colorado at Colorado Springs. His opinions do not necessarily reflect those of the University of Colorado.
